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1
Q

What is the relationship between lesion’s agrressivness, rate of reccurance and follow up duration ?

A

the more aggressive the biologic behavior, the higher risk of
recurrence, and the longer the follow up needed for the patient

2
Q

What is the spectrum of benign and malignant lesions

A
3
Q

Which lesions are considered benigns

A

Things that have a very low rate of recurrence when you do a conservative excision or a nucleation ►they’re going to be very benign and they’re not going to be likely to be recurrent:
Odontoma and radicular cysts are way down here near the benign side
AOT (Adenomatoid Odontogenic Tumor) is benign.
COCs (Calcifying odontogenic cyst) are benign.
OKCs (Odontogenic keratocyst) ‐ they’re benign.
▪ Even Ameloblastomas are benign

4
Q

which lesions are on the malignant side?

A

But eventually you get over to the side over here where you can have something like an Ameloblastic carcinoma ‐ truly malignant –> We know that it can metastasize and it can lead to death
▪ Lesions like Ameloblastomas and CEOTs will need to be managed more aggressively. (Not just curettage, aka surgical scraping or cleaning)
o You have a resection ‐ either a portion of the mandible is
removed or a segment of the mandible is removed.

5
Q

What are the 3 Classification of
benign tumors?

A
  1. Epithelial
  2. Mesenchymal
  3. Mixed
6
Q

What are the list of Epithelial Benign Tumors?

(5)

A

▪ Ameloblastoma
▪ Adenomatoid odontogenic tumor
▪ Calcifying epithelial odontogenic tumor
▪ Squamous odontogenic tumor

Odontogenic keratocyst (aka Keratocystic odontogenic tumor)

7
Q

What are the list of Mesenchymal Benign Tumors?

(5)

A

▪ Odontogenic myxoma
▪ Central Odontogenic fibroma
▪ Cementifying fibroma
▪ Cementoblastoma
▪ Granular cell odontogenic tumor

8
Q

What are the list of Mixed Benign tumors?

5

A

▪ Odontoma (complex and compound)
▪ Ameloblastic fibroma/odontoma
▪ Primordial odontogenic tumor
▪ Dentinogenic ghost cell tumor
▪ Calcifying cystic odontogenic tumor
(aka COC, ghost cell tumor)

9
Q

Ameloblastoma

Charcterstics

A
  • An epithelial odontogenic neoplasm (Tumor of Epithelial Origin)
  • with a close histologic resemblance to the enamel organ
10
Q

Ameloblastoma

Origin

A

Potential sources of epithelium include:

o Enamel organ – look like they’re about to deposit a
substance but never do

o Odontogenic rests (Malassez, Serres)

o Reduced enamel epithelium

o Epithelial lining of odontogenic cysts ‐ can actually have an ameloblastoma arise within a dentigerous cyst

11
Q

Ameloblastoma

Radiographically

A

-Osteolytic tumor (radiolucent – no hard tissue formed)

  • Well-circumscribed uni- or multilocular radiolucency
  • Often with sclerotic or corticated borders
  • May see blunt root resorption and displacement of teeth
  • Frequently seen in association with unerupted teeth
12
Q

Ameloblastoma

Clinically

A
  • Rather slow growing tumor
  • Larger lesions present as painless expansion or swelling of bone
  • Smaller ones are asymptomatic, can be seen on routine imaging
  • Buccal and lingual cortical expansion is common
  • May perforate cortical plate and invade surrounding soft tissue
  • Can arise in a dentigerous cyst (see transition from stratified
  • squamous to ameloblastic epithelium)
13
Q

Ameloblastoma

Demographics

A

11‐18% of non‐cystic lesions of the maxillofacial bones
4th and 5th decade most common, but occurs over a broad age range (rare in first decade)
o Usually starts 2nd decade, can go up to 80‐90s. Late 30s/early 40s are usually the peak
▪ > 80% occur in the mandible (most in molar/ramus area)

14
Q

ameloblastoma

location

A

▪ Almost 80% or a little over 80% (of ameloblasts) are down in the mandible.
▪ And the vast majority are in the posterior mandible
▪ Do occur in maxilla but at lower rate

15
Q

Ameloblastoma

Etiology

A

▪ Over expression of Bcl‐2 (anti‐apoptotic protein)
Expression of fibroblast growth factor (FGF)
Over expression of matrix metalloproteinases (MMPs 9 and 20) – like in OKC, allowing tumor to grow into surrounding area
▪ Surprisingly, no significant increase in Ki‐67 expression (cell
proliferation marker) – ameloblastomas do NOT turn over rapidly

16
Q

What is

the second most common

odontogenic neoplasm?

A

Ameloblastoma

(after odontoma)
o although odontomas are more like hamartomas

17
Q

Which tumor can arise in a dentigerous cyst?

A

Ameloblastoma

(we see transition from stratified squamous to ameloblastic epithelium)

18
Q

Ameloblastoma

Types

A

Conventional/multicystic/solid/ (~ 80%)

  • Unicystic (~6-15%) need entire specimen (excision) to know
  • Desmoplastic
  • Peripheral
  • Malignant
19
Q

What is this radiographic finding?

A

Unilocular and unicystic ‐ An example of a unilocular ameloblastoma that is
not associated with an impacted tooth
▪ Is between roots of two teeth, may be confused with lateral
periodontal cyst. Well‐circumscribed radiolucency

20
Q

What is this radiographic finding?

A

▪ Typical appearance for ameloblastoma

Multilocular, very well‐circumscribed, associated with impacted tooth.

Can see bowing of inferior aspect of mandible

lateral oblique radiograph.was used here

21
Q

What is this radiographic & clinical finding?

A

Ameloblastoma

clinically: Have expansion of the buccal plate, obliterating the vestibule in this area.

Radiographically: Root resorption of molar, unilocular radiolucency in mandible

22
Q

What is this radiographic finding?

A

Ameloblastoma

  • Small lesion distal to impacted tooth.
  • Unilocular radiolucency with elevation of alveolar ridge + some expansion of soft tissue
23
Q

What is this radiographic finding?

A

Ameloblastoma

Well‐circumscribed radiolucency with a sclerotic or
corticated margin
.

▪ If you had a CBCT, it would probably show you that there
was a thin septa in this area of residual bone trabeculae.

Fracture could be caused by very large cysts.

Resolve by decompressing unless with odontogenic tumor – need to remove the mandible 1cm+ on either side of lesion

24
Q

Conventional/Solid Ameloblastoma

Treatment

A
  • Resection (treatment depends on extent of the lesion and anatomy of involved bone)
  • Segmental
  • Composite
  • Long term (decades) follow up is needed for these patients
25
Q

Case

16yo female

Describe the lesion and what is the diagnosis?

A

▪Left mandible, multilocular radiolucency associated with impacted tooth
▪ It’s well circumscribed, edge may be a little bit sclerotic or corticated
▪ It has displaced an impacted tooth down towards the inferior
aspect of the mandible
▪ Appears to be expanding the cortex of the mandible in areas
▪ There’s blunt resorption of the teeth adjacent (PMs and molar)

Ameloblastoma

26
Q

Case

Well‐circumscribed radiolucency, no impacted tooth
▪ But notice that it’s coming up to posterior aspect of first molar
Surgery done to remove lesion, left inferior aspect of mandible

Follow‐up image: conservative surgery but still removed bone up to mesial aspect. Less conservative would be removing entire mandible
▪ Concern with that is paresthesia (from removing the nerve as well)

A

Conventional/Solid Ameloblastoma

27
Q

Unicystic
ameloblastoma

types

Subgroup of
ameloblastomas

A

Unicystic (Simple or luminal)

  • lumina- confined to the surface lining of the cystic space

Plexiform (intraluminal)

  • intralumina-one or more areas of the ameloblastic epithelial lining, proliferate into the lumen of the cystic space

Mural – hard to distinguish from conventional,
so pathologists think they should NOT be treated the same as unicystic (which would be a more conservative treatment)
Ameloblastoma arising in a cyst ‐ can usually be treated in a similar way as unicystic ameloblastoma.

28
Q

Unicystic Ameloblastoma

Demographcics and Locations

A

Younger initial presentation (~ 50% in 2nd decade)
90% in MD (mandibular)
▪ Typically asymptomatic and found on routine radiographic exam

29
Q

Unicystic Ameloblastoma

Radiographically

A
  • Commonly a well‐circumscribed radiolucency that surrounds the crown of an unerupted tooth
  • Commonly accompanied by root resoprtion
30
Q

Unicystic Ameloblastoma

radiographically can be confused with which cyst?

A
  • Radiographically can be confused with dentigerous cyst
    • Presence of root resorption should increase your suspicion of ameloblastoma
31
Q

What is this radiographic finding?

A

Unicystic Ameloblastoma

but could be

Dentigerous Cyst

based on clinical presentation!

So radiograph is not diagonstic

32
Q

Unicystic Ameloblastoma

Treatment

A
  • Treatment is typically enucleation and curettage
    • Reports of lower rate of recurrence (10‐20%) than conventional ameloblastoma (50‐90%) with similar treatment
    • Some recommend decompression prior to surgery
  • Use of Carnoy’s solution after enucleation- resulted in a recurrence rate lower
33
Q

Desmoplastic
Ameloblastoma

Location

A
  • Anterior jaws (particularly maxilla)
34
Q

Desmoplastic
Ameloblastoma

Radiographically

A
  • looks “fibro‐osseous” due to mixed radiolucentradiopaque appearance
    • Mineralization of dense collagen
  • Well‐circumscribed, corticated.
35
Q

What is this radiographic finding?

A

Desmoplastic
Ameloblastoma

  • Spherical growth. Within it, has both radiodense and radiolucent areas (is
  • mixed radiolucent‐radiopaque)– similar appearance to benign fibro‐osseous lesions.
  • Well‐circumscribed, corticated.
36
Q

Peripheral
Ameloblastoma

Origin and Charcterstics

A
  • Thought to arise from epithelial rests or basal cells in the gingiva
  • Uncommon
  • Does not invade underlying bone
  • Histology is the same as conventional type
37
Q

Peripheral
Ameloblastoma

location

A
  • Found on gingiva or alveolar mucosa (*that’s why it’s named peripheral or extraosseous)
38
Q
A

Peripheral
Ameloblastoma

39
Q

What are the two types of “Malignant”
Ameloblastomas ?

A
  1. Malignant ameloblastoma
  2. Ameloblastic carcinoma
40
Q

What is a malignant ameloblastoma?

A

▪ Malignant ameloblastoma
o Primary lesion and metastasis have normal welldifferentiated
ameloblastic (benign) histology
o Most commonly to lung

41
Q

What is Ameloblastic carcinoma?

A
  • a primary lesion has atypical poorly‐differentiated
  • neoplastic(malignant) histology
  • may metastasize
42
Q

CALCIFYING EPITHELIAL ODONTOGENIC TUMOR

CEOT

also known as ?

A

Pindborg Tumor

43
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

A

▪ Uncommon (~1% of odontogenic tumors)
▪ Does not have inductive effect

44
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Demographics and Location

A

o 2nd to 10th decades, peak ~ 4th decade
o MD (mandibular) 2 : 1 MX (maxillary)
o Usually posterior mandible

45
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Clinically

A
  • Presents as painless slowly expanding swellings
  • sessile swellings of the gingiva or alveolus ( 2 times more on mandible than maxilla
  • Peripheral lesion may be seen, but are rare
46
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Radiographically

A
  • May be unilocular, but most commonly as a multilocular lesion
  • May be entirely radiolucent or a mixed radiolucent-radiopaque lesion
  • Often associated with an unerupted tooth
    • MD third molar most common
  • Calcifications in the lesion, if present, are typically prominent around the crown of the impacted tooth.
47
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT) have clinical presentation similar to what lesion?

A
  • CEOT clinically is similar to ameloblastoma
  • Also, CEOT has potential to be locally invasive, if in the right anatomic location, but has a less aggressive biologic behavior compared to ameloblastoma
48
Q

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Treatment

A

Enucleation _with peripheral ostectom_y
Resection with rim of normal bone
Recurrence rate is ~12%
~ 2% demonstrate malignant transformation

49
Q

case

A

Calcifying Epithelial Odontogenic Tumor

(CEOT)

Clinically: we see a little expansion on inferior aspect of mandible + lingual too

Radiographically: we see well‐circumscribed, a little corticated/sclerotic edge, impacted tooth
▪ we can see bowing of inferior aspect of mandible
▪ Within areas of radiolucency, see areas of opacity (calcified lesions = classic CEOT)
When smaller► could have looked *unilocular*

50
Q

What is this radiographic finding?

A

Calcifying Epithelial Odontogenic Tumor(CEOT)

  • flecks of calcifications.
  • Calcifications all around crown is common
51
Q

What is this radiographic finding?

A

Calcifying Epithelial Odontogenic Tumor(CEOT)

  • Multilocular radiolucency with calcifications.
  • an expansion up to PMs and back to 2nd molar
  • as well as bowing of mandible.
52
Q

What is this radiographic finding?

A

Calcifying Epithelial Odontogenic Tumor(CEOT)

  • Fewer calcifications here, well‐circumscribed and corticated, impacted tooth.
  • periosteal reaction causing elevation at the bottom of image!
53
Q
A

Calcifying Epithelial Odontogenic Tumor(CEOT)

  • well‐circumscribed radiolucency with calcifications in lower anteriors
54
Q

Adenomatoid odontogenic tumor

(AOT)

Demographics and Location

A

▪ 2/3 anterior jaws
▪ 2/3 females
▪ 2/3 associated with an impacted canine
▪ 2/3 MX
▪ 2/3 2nd decade – kids and teenagers\

That’s why it’s known as the tumor of two thirds

▪ ~ 3‐7% of all odontogenic tumors

New research showing more in _ant md_ though

55
Q

Adenomatoid odontogenic tumor

(AOT)

Clinical charcterstics

A
  • Frequently asymptomatic, discovered upon routine radiographic exam or when lesion becomes large enough to expand bone
  • Tumor of Epithelial Origin
56
Q

Adenomatoid odontogenic tumor

(AOT)

Origin

A
  • thought to arise from remnants of the dental lamina in the gubernacular cord /canal
57
Q

Adenomatoid odontogenic tumor

(AOT)

Radiographically

A

~ 75% are well‐circumscribed unilocular radiolucency involving the crown of an unerupted tooth
o less often, they are found between the roots of teeth
Mixed radiolucent/radiopaque appearance is likened to “snowflake” calcifications
▪ May be totally radiopaque in some cases
▪ Divergence of roots is frequently seen

58
Q

If an Adenomatoid odontogenic tumor (AOT) is not showing any calcifications yet, it’s in the differential
diagnosis with —— ?

A

a dentigerous cyst.

59
Q

Adenomatoid odontogenic tumor

(AOT)

Treatment

A
  • Treatment is usually enucleation
  • recurrence is rare
60
Q

What is the DD?

A

well‐circumscribed radiolucency at crown of an impacted canine
Hard to tell if attaches at CEJ.

If further down, less likely a dentigerous cyst and more likely AOT, ameloblastoma, or OKC

61
Q

What is this radiographic finding?

A

we see calcifications forming, with both radiolucent and radiolucent areas.
▪ Dentingerous cyst, ameloblastoma, and OKC are NO LONGER in the differential diagnosis.

This is clearly AOT

_(_Adenomatoid odontogenic tumor)

62
Q

What is this clinical finding?

A

Adenomatoid odontogenic tumor

(AOT)

Swelling in maxillary vestibule

63
Q

What is this clinical finding?

A

Adenomatoid odontogenic tumor

(AOT)

fibrous capsule of AOT is at least partially encapsulated.

Easy to remove; “popped right out”.

64
Q

What is this clinical finding?

A

Adenomatoid odontogenic tumor

(AOT)

An expansion into lingual area as well as into vestibule

65
Q

What is this radiographic finding?

A

Adenomatoid odontogenic tumor

(AOT)

Snowflake‐like calcifications within mixed, well‐circumscribed radiolucency

66
Q

What is this radiographic finding?

A

Adenomatoid odontogenic tumor

(AOT)

  • Teardrop shape / inverted pear between roots of teeth.
  • Well-circumscribed, corticated margin & snowflake‐like calcifications within
67
Q

Squamous Odontogenic Tumor

(SOT)

Demographics and Location

A

▪ Typically involves alveolar ridge
▪ Anterior > Posterior jaws
▪ Seen from 2nd to 7th decade (mean 40 years of age)

68
Q

Squamous Odontogenic Tumor

(SOT)

Clinical charcterstics

A
  • Tumor of Epithelial Origin
  • Rare
  • Usually asymptomatic, but may present with tooth mobility and slight pain
  • Multiquadrant ~ 20-25%
    • A couple reported cases in families
69
Q

Squamous Odontogenic Tumor

(SOT)

Radiographically

A
  • Well‐circumscribed radiolucency , often a semilunar radiolucency of alveolar ridge
    • Can mimic periodontal disease
70
Q

Squamous Odontogenic Tumor

(SOT)

Origin

A
  • Thought to arise from epithelial rests (Malassez) in the periodontal ligament space
71
Q

Squamous Odontogenic Tumor

(SOT)

Treatment

A
  • Treatment is conservative local excision
  • Recurrence is rare
72
Q

Squamous Odontogenic Tumor SOT
Histologically may be mistaken for what other lesions?

A
  • Ameloblastoma
  • Squamous cell carcinoma (SCCa)
73
Q

What is this radiographic finding?

A

In addition to fracture, there is semilunar loss of bone around the molars ► (SOT)

Squamous Odontogenic Tumor

74
Q

What is this radiographic finding?

A

SOT

Squamous Odontogenic Tumor

  • Semilunar loss of bone.
  • Alveolar bone is gone due to impacted canine that is visible
75
Q

Central odontogenic fibroma (COF)

also known as ?

A
  • *Odontogenic Fibroma
    (central) **
76
Q

Central odontogenic fibroma

(COF)

Origin

A
  • Tumors of Mesenchymal Origin
  • Some believe represents the counterpart to the peripheral ossifying (odontogenic) fibroma (in soft tissue)
77
Q

Central odontogenic fibroma

(COF)

Location

A
  • MX ≈ MD
  • lesions in MX tend to be anterior to first molar
  • those in MD anterior ≈ posterior
  • 1/3 associated with an unerupted tooth
78
Q

Central odontogenic fibroma (COF)

Clinically

A

-Small lesion tend to be asymptomatic

-Larger lesions can cause cortical expansion and tooth mobility

79
Q

Central odontogenic fibroma

(COF)

Radiographically

A
  • Small lesions tend to be well-circumscribed unilocular radiolucencies
    • often periradicular
      • can mimic periapical granulomas and cysts
  • Larger lesions tend to be well-circumscribed multilocular radiolucencies
  • Borders are usually sclerotic
  • Root resorption or divergence may be seen
  • ~ 10- 15% will show radiopaque flecks within the radiolucency
80
Q

Central odontogenic fibroma

(COF)

Treatment

A
  • Enucleation with curettage or excision
  • usually don’t recur
81
Q

What is the Microscopic Differential Diagnosis of Central odontogenic fibroma (COF)?

A

o Desmoplastic fibromaa more aggressive lesion
o Fibromyxoma variant of odontogenic myxoma with
abundant collagen

o Hyperplastic tooth follicle ‐ typically loose immature stroma, but when hyperplastic can have abundant collagen

82
Q

What is this radiographic finding?

A

Central odontogenic fibroma (COF)

  • well‐circumscribed radiolucency posterior to molar
83
Q

What is this radiographic finding?

A

Central odontogenic fibroma (COF)

round mass of opacity due to FCT. Ground glass‐like appearance

84
Q

Odontogenic Myxoma

Origin

A
  • Tumors of Mesenchymal Origin
  • Thought to arise from the tooth follicle or dental papilla
85
Q

Odontogenic Myxoma

Demographics and Location

A
  • ~3-5% of all odontogenic tumors
  • Wide age range, but 3rd decade most common
  • Found anywhere in the MD or MX
86
Q

Odontogenic Myxoma

Radiographically

A
  • Small lesions present as asymptomatic radiolucencies found upon routine exam
  • Larger lesions can cause painless expansion of bone
  • All are radiolucent lesions, but the appearance can vary from well‐ circumscribed to irregular and diffuse
  • Unilocular to, more commonly, multilocular (“soap bubble” or “honeycomb”) radiolucency
  • Borders are often scalloped, can see sc_alloping around the roots of teeth_
    • But can cause displacement of teeth and resorption of the roots of teet
87
Q

Odontogenic Myxoma

Grossly

A
  • the tumor is described as loose, soft and gelatinous
88
Q

Odontogenic Myxoma

Treatment

A
  • Surgical excision or resection
  • Because the lesion is not encapsulated and has a gelatinous loose consistency► it is difficult to remove completely
    • this is thought to be why myxoma has a fairly high recurrence rate
  • Maxillary posterior lesions should be treated more aggressively
89
Q

What is this radiographic finding?

A

Odontogenic Myxoma

  • Classic example of enlargement of the mandible caused by multilocular radiolucency.
  • Enlarged into oral cavity ‐ alveolar ridge elevated
90
Q

What is this radiographic finding?

A

Odontogenic Myxoma

91
Q

Case

A

Clinically: obliteration of vestibule on patient’s left mandible

Radiographically:lesion running from posterior by third molar all the way anterior to canine. Well‐circumscribed, multilocular radiolucency is scalloping up
between teeth, causing some root divergence

Grossly: gelatinous appearance of myxoma makes it hard to remove

After treatment: post‐surgery; had excised all the way to right 2nd PM

This is Odontogenic Myxoma

92
Q

CEMENTOBLASTOMA

Origin

(True Cementoma)

A
  • Tumor of Mesenchymal origin
  • Benign tumor of cementoblasts
93
Q

CEMENTOBLASTOMA

Demographics and Location

(True Cementoma)

A
  • Typically present in 2nd and 3rd decade (~75% prior to the age of 30)
  • 75% MD
    • ▪ ~ 90% in molar/premolar region
      *
94
Q

CEMENTOBLASTOMA
(True Cementoma)

Clinically

A
  • 2/3 of cases have pain and swelling
  • Can cause cortical expansion if large enough
95
Q

CEMENTOBLASTOMA
(True Cementoma)

Radiographically

A
  • Radiopaque mass fused to the root of the affected tooth
  • Usually has a thin radiolucent halo or rim surrounding the radiopacity
96
Q

CEMENTOBLASTOMA

Treatment

(True Cementoma)

A
  • surgical extraction of the involved tooth with attached tumor
  • Root amputation (with attached tumor) and endo is an option for smaller lesions
  • Recurrence is unlikely
97
Q
A

CEMENTOBLASTOMA
(True Cementoma)

  • First molar has tumor attached to the root.
  • Mostly radiopaque but has some less radiodense areas within = classic for cementoblastoma.
  • Radiolucent halo around region.
98
Q

Cementoblastoma has similar histologic presentation to what?

A

osteoblastoma

Difference is Osteoblastoma is NOT a_ttached to the root of a tooth_ (whereas cementoblastoma must be)

99
Q

What is this gross and histological finding?

A

Cementoblastoma

Grossly continuous growth from tumor to the root of the tooth. Brownish
areas were more vascular.
Histologically: tubular dentin in tooth, attached to mass of tissue with calcifications

100
Q

What are Odontogenic Tumors
of
Mixed Origin

(Epithelial and
Mesenchymal)

A

They are tumors in which the _odontogenic epithelial componen_t causes induction of the mesenchymal component to produce a product

Examples:

  • Odontomas
  • Ameloblastic fibroma
    • (and Ameloblastic fibrosarcoma)
  • Ameloblastic fibro-odontoma
101
Q

Odontoma

Origin

A
  • Odontogenic Tumors of Mixed Origin (Epithelial and Mesenchymal
  • They are hamartomas rather than true neoplasms
  • They are masses of enamel and dentin with variable amounts of pulp and cementum
102
Q

What is the most common odontogenic “tumor”?

A

Odontoma

103
Q

Odontoma

Demographics and Locations

A

First 2 decade most common (mean age of 14)

Location is based on the type of Odontoma

  • Compound Odontoma
    • Anterior jaws (esp. MX)
    • **Well developed rudimentary “tooth” forms
  • Complex Odontoma
    • Posterior jaws (esp. MD)
    • **Poorly developed mass of calcified deposits
104
Q

Odontoma

Charcterstics

A
  • Often associated with an unerupted tooth
  • Lesions may prevent eruption of teeth
  • Usually small in size, but rare cases of > 6cm reported
  • large lesions can cause bone expansion
105
Q

Odontoma

Radiographically

A

▪ Radiographically see a radiopaque structure(s) surrounded by a radiolucent rim
▪ As with any calcified lesion, those found early in development may appear totally or predominantly radiolucent
Compound odontomas appear as small tooth‐like structures
Complex odontomas look like masses of radiopaque material with variable densities

106
Q

Odontoma

Treatment

A

Simple excision or enucleation
Unlikely to recur

107
Q

Compound Odontoma

Vs

Complex Odontoma

A

Compound Odontoma

  • Mature normal appearing pulp, enamel and dentin
  • Organization like teeth, with enamel surrounding dentin which surrounds pulp ( Well developed rudimentary “tooth” forms)
  • appear as small tooth‐like structures in the Anterior jaws (esp. MX)

Complex Odontoma

  • Mature pulp, enamel and dentin
  • No organization, mass of dentin and enamel matrix and pulp tissue (**Poorly developed mass of calcified deposits)
  • appear as masses of radiopaque material with
  • variable densities in the Posterior jaws (esp. MD)
108
Q

What is this radiographic finding?

A

Classic appearance of Odontoma

  • multiple tooth‐like shapes aggregated together
  • Typically with some sort of radiolucent halo around them
109
Q

What is this radiographic finding?

A

Compound Odontoma

little teeth‐like structures blocking canine eruption

110
Q

What is this radiographic finding?

A

Complex Odontoma

  • 2‐2.5cm mass overlaying the molar.
  • radiolucent rim/halo that is mixed, mostly radiopaque
111
Q

Primordial
odontogenic tumor
(POT)

Origin

A
  • Tumor of mixed origin
  • Very rare! first reported in 2014 -less than 30 cases so far
112
Q

Primordial
odontogenic tumor
(POT)

Demographics and Location

A
  • Most common in 1st and 2nd decades
    • Mean age 12.5 years
  • MD:MX 6:1
113
Q

Primordial
Odontogenic Tumor
(POT)

Clinical Charcterstics

A
  • Asymptomatic found on routine imaging
  • Can cause tooth displacement and cortical expansion
114
Q

Primordial
Odontogenic Tumor
(POT)

Radiographically

A
  • Well-defined radiolucency associated with an impacted tooth
    • Most commonly a third molar
115
Q

Primordial
Odontogenic Tumor
(POT)

Treatment

A
  • conservative excision/enucleation
  • So far no recurrence
116
Q

Case

A

Primordial
Odontogenic Tumor
(POT)

unilocular radiolucency

117
Q

Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO)

Charcterstics

A
  • Uncommon benign mixed odontogenic neoplasms.
  • Considered together because it is thought they are variations of the same process
118
Q

Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO)

demographics and location

A
  • Typically presents in first 2 decades
    • mean is 12 years of age
  • ~ 70% occur in the posterior mandible
  • ~ 75% associated with unerupted teeth
119
Q

Ameloblastic Fibroma (AF)

clinical and radiographic presentations

A
  • Small lesions are asymptomatic and found on routine exam
  • Large lesions can cause bone expansion
  • Smaller lesions are unilocular Radiolucencies
  • Large ones are multilocular radiolucencies
  • Border is well defined and often sclerotic
  • Untreated, can grow to very large size
120
Q

What is this radiographic finding?

A

Ameloblastic Fibroma
(AF)

1‐3 potential locules, no impacted tooth associated

121
Q

Ameloblastic Fibro-odontoma (AFO)

Clinical and Radiographic features

A
  • Clinical features similar to Ameloblastic Fibroma AF (Small lesions are asymptomatic and found on routine exam
    & Large lesions can cause bone expansion)

Radiographically, we see a mixed radiolucent/radiopaque lesion because of the formation of odontomas

122
Q

What is this radiographic finding?

A

Ameloblastic Fibro-odontoma (AFO)

  • well‐circumscribed radiolucency
  • corticated edge + calcification
123
Q

What is this radiographic finding?

A

Ameloblastic Fibro-odontoma (AFO)

has expansion into oral cavity. Flecks of calcification
in lesion with impacted tooth = odontoma

124
Q

Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO)

Treatment

A
  • Conservative surgical excision or curettage,
    easily removed from surrounding bone
  • Prognosis is excellent, recurrence is unusual
  • Rare cases reported of development of ameloblastic fibrosarcoma in area of AF or AFO
125
Q

Ameloblastic
Fibrosarcoma

Charcterstics & Origin

A
  • _Malignant counterpar_t of ameloblastic fibroma
  • Rare lesion which may arise in the site of a previous AF/AFO or arise de novo
126
Q

Ameloblastic
Fibrosarcoma

Demographics and location

A
  • 1.5 times more common in males
  • ~ 80% MD
127
Q

Ameloblastic
Fibrosarcoma

Clinically

A
  • Pain, swelling and rapid growth are common presenting signs
128
Q

Ameloblastic
Fibrosarcoma

Radiographically

A
  • presents as an ill-defined destructive radiolucency with irregular borders
129
Q

Ameloblastic
Fibrosarcoma

Treatment

A
  • Radical surgical excision as the tumor is very aggressive and infiltrative
  • Prognosis is dependent on complete removal of tumor
130
Q

What is this radiographic finding?

A

Ameloblastic Fibrosarcoma

in the mandible developed after two years from AF

131
Q

Odontogenic carcinomas

List them (5)

A

-Ameloblastic carcinoma

-Primary intraosseous carcinoma, NOS

-Sclerosing odontogenic carcinoma

-Clear cell odontogenic carcinoma

-Ghost cell odontogenic carcinoma

All fairly rare lesions!

132
Q

What is the Differential Diagnosis D/D of Multilocular Radiolucency

A

MOCHA

  • M odontogenic Myxoma
  • O Odontogenic keratocyst
  • C Central giant cell granuloma
  • H Central Hemangioma
  • A _A_meloblastoma

Others:

  • Aneurysmal bone cyst
  • early CEOT
  • ameloblastic fibroma AF
  • central MECa